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Abstract 摘要

The medical reform in China over the past decade is facing various challenges, such as physician-patient relations, healthcare allocation, and the ethics of medical professionalism. This paper attempts to argue that the medical situation in China today cannot be fully understood without examining its cultural, social, and political superstructure, which clarifies the situation in China in the current transitional stage. The studies described in the paper are based on documented literatures that include various “ideal types” in terms of moral philosophies and governmental policies intended to resolve the problems at the practical level. Nevertheless, the attempt to uncover what they refer to as a form of “structural bioethics” could directly influence the on-going medical reform today as well as the re-construction of bioethical theory in China. The approach taken in the paper is historical, textual, and sociological.

改革開放以來,中國醫藥衞生體制改革實踐面臨諸多問題,其中包括政治、經濟、社會、文化和倫理議題。醫護人員的價值觀念、道德判斷、行為規範和專業精神的危機集中體現在生命倫理學結構性困境狀況之中。現時中國醫患關係空前絕後的結構性緊張狀況正是最典型的例證。本文試圖從中國道德哲學、道德社會史、中國社會史和醫學社會史等視角,運用文獻回顧、衞生政策比較研究和案例分析等方法,回顧西方倫理學史及其個人主義生命倫理學典範之歷史演變;並在中國社會結構性轉型與醫藥衞生體制改革的宏觀社會處境下,分析中國道德哲學和生命倫理學的思想傳統及其面臨的挑戰。文章根據醫藥衞生體制改革和生命倫理學實踐,提出具中國特色的“結構性倫理學和結構性生命倫理學”。作者試圖闡述“結構性倫理學與結構性生命倫理學”體系的內涵外延、構成要素、範圍內容、基本特點和結構性成因,尤其是這種體系對目前中國醫藥衞生體制改革政策之意義。

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